aterials Transfer











Students name: ______________________________________ Date: ___________________________
Current School: _____________________________ Current Case Manager: _______________________
Name of person completing this form: ______________________________________________________
Equipment transferring for summer to: _______________________________________ (name of school)
Receiving person:________________________________________________________________________
After summer school, equipment should be returned to: ___________________________ (name of school)
(Provide new case managers name if known) __________________________________________________
For student (not going to summer school) equipment goes to _______________________ (name of school)
(Provide new case managers name if known) __________________________________________________
List equipment and instructional materials below:

If available, provide RCS #s or write NA

Item Name _________________________________
RCS number________________________
Item Name _________________________________
RCS number________________________
Item Name _________________________________
RCS number________________________
Item Name _________________________________
RCS number________________________
Item Name _________________________________
RCS number________________________
Item Name _________________________________
RCS number________________________
Item Name _________________________________
RCS number________________________
Item Name _________________________________
RCS number________________________

(If one page is not enough, please fill out another copy of this page. Type page 2 at top right)

(1) Please
complete and e-mail to Bonnie Nelson as an attachment
. Save attachment with school initials first
2 student initials next. For example if youre making a list for John Doe who is currently at Mountain
View , save this document as MVE JD. Please do not copy and mail or fax to me. If you do not
know how to send attachments, ask tech coordinator in your school for help. If you need to add
additional equipment after sending, please add to original list and send complete new list with the
same name.

(2) After completing, please print out and
send a copy of this list with materials being sent to receiving school.
This should be done before you leave school for the summer
.

(3) If equipment is heavy, the case manager should e-mail Lois Defibaugh to arrange for pick up and delivery.
Remember the school name goes on outside of paper and students name goes inside folded sheet of
paper attached to equipment.

(4) If equipment with RCS numbers goes home, e-mail Gail Jennings for that form which must be signed by
parents and school personnel and returned to Gail

*Any questions, please e-mail Bonnie Nelson.